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Page 5 of 5 <br /> Division records indicate the following permittee contact information. If this information is not current,please type or print <br /> current contact information: <br /> Permittee Contact: Jeffrey L. Schumacher <br /> Permittee Company: Jeffrey L. Schumacher <br /> Address: 18751 County Road 37.5 <br /> Sterling, CO 80751 <br /> Phone Number: (970) 520-5683 <br /> Fax Number: <br /> Email Address: Jeff.schumacher@premieraca.com <br /> 1,the undersigned,hereby state that the information provided in this report is true and accurate,and that site operations are <br /> being conducted in accordance with the Division approved mining and reclamation plans. <br /> , . LL" <br /> -3- /- /!p <br /> 4AAre of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />